<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="format-detection" content="telephone=no" />
    <meta content="email=no" name="format-detection" />
    <script src="build/flexible.js"></script>
    <script src="build/flexible_css.js"></script>
    <link rel="stylesheet" href="css/reset.css">
    <link rel="stylesheet" href="css/main.css">
    <link rel="stylesheet" href="css/icons.css">
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    <link rel="stylesheet" href="ie7/ie7.css">
    <!--<![endif]-->
    <title>填写资料</title>
</head>
<body>
<header>
    <div class="header-tit box box-left box-center">
        <div class="item-fix header-icon"><a href="serviceDescribe.html" class=" icon-back"></a></div>
        <h1 class="item">填写资料</h1>
        <div class="item-fix icons-square"></div>
    </div>
</header>
<section class="section-single section-nav">
    <div class="list-tit font14">资料提交后，将有专员与您联系！</div>
    <ul class="list">
        <li>
            <div class="box box-left box-center">
                <label class="box box-left box-center item">
                    <em class="list-inp-tit font16 item-fix">地址</em>
                    <a href="selectCommunity.html" class="place-chose item box box-between box-center">
                        <em class="list-inp item"><input type="text" placeholder="请选择您的地址" readonly></em>
                        <i class="advice-icon icon-change item-fix font16"></i>
                    </a>
                </label>
            </div>
        </li>
        <li>
            <label class="box box-left box-center">
                <em class="list-inp-tit font16 item-fix">姓名</em>
                <em class="list-inp item"><input type="text" placeholder="请输入您的姓名"></em>
            </label>
        </li>
        <li>
            <div class="box box-left box-center radio">
                <div class="list-inp-tit font16 item-fix">年龄</div>
                <div class="list-inp item font16">
                    <label class="radio-main">
                        <input type="radio" name="sexy" checked>
                        <i class="radio-btn"></i><i class="radio-word">男</i>
                    </label>
                    <label class="radio-main">
                        <input type="radio" name="sexy">
                        <i class="radio-btn"></i><i class="radio-word">女</i>
                    </label>
                </div>
            </div>
        </li>
        <li>
            <div class="have-btn box box-left box-center">
                <label class="box box-between box-center item">
                    <em class="list-inp-tit font16 item-fix">手机号</em>
                    <em class="list-inp item"><input type="tel" placeholder="请输入手机号"></em>
                </label>
                <div class="item-fix have-btn-square">
                    <i class="common-btn btn-grey font12">获取验证码</i>
                </div>
            </div>
        </li>
        <li>
            <label class="box box-left box-center">
                <em class="list-inp-tit font16 item-fix">验证码</em>
                <em class="list-inp item"><input type="text" placeholder="请输入验证码"></em>
            </label>
        </li>
    </ul>
</section>
<footer>
    <div class="footer-btn font18">
        <a href="">立即报名</a>
    </div>
</footer>
</body>
</html>